Perioperative, Oxygenation, and Perfusion Flashcards
What are the three classifications of surgery based on?
- Urgency
- Degree of Risk
- Purpose
What type of surgeries can be delayed and scheduled in advance based on patients choice
Elective/Minor
What classification of surgery need to be completed within 24-48 hours?
Urgent
When must an emergency surgey be completed?
immediately
What is an Ablative surgery?
removes a diseased body part
appendectomy, amputation, colon resection
What is palliative surgery?
To relieve or reduce intensity of an illness
It is not curative
What type of surgery has the following characteristic?
- Restores function to traumatized or malfunctioning tissue
- To improve self-concept
Reconstructive surgery
What are the four types of anesthesia?
- General (systemic)
- Moderate sedation/analgesia
- Regional
- Topical and Local
Which classification of anesethia causes loss of consciousness, skeletal muscles, and depresses reflex?
General (systemic) anesthesia
Which classification of anesthesia has the most risks?
amnesia, nausea, respiratory depression, paralysis of bladder, and anaphylaxis (of medication used), death. Loss of gag reflex possibly (can cause aspiration)
general (systemic) anesthesia
which anesthesia has the following characteristics?
- Conscious sedation, patient maintains own cardio/respiratory function.
- Used in short-term and minimally invasive procedures
Moderate sedation/analgesia
What are the three types of regional anesthesia?
- Nerve block
- Spinal anesthesia
- Epidural anesthesia
Which anesthesia has the following characteristic?
- Accomplished by injecting a local anesthetic around a nerve trunk supplying the area of surgery.
Nerve block
Which anesthesia has the following characteristic?
- Achieved by injecting a local anesthetic into the subarachnoid space through a lumbar puncture, causing sensory, motor, and autonomic blockage.
Spinal anesthesia
Which anesthesia has the following characteristic?
- Is the injection of an anesthetic agent to a specific area of the body.
topical or local anesthesia
Which anesthesia has the following characteristic?
- Involves the injection of the anesthetic through the intervertebral spaces, usually in the lumbar region (although it may be also sued in the thoracic or cervical regions)
Epidural anesthesia
What is the 3 Nursing Responsibilities during the “Informed Consent”?
- Witness of the signature (ensuring patient is A&O)
- Outline patients rights and their right to refuse
- Reinforce provider education (purpose, expected outcomes, side effects)
If a patient is unconscious, surgery can be done for what reason?
To save their life due to “good samaritan act”.
What are the usual pre-surgical screening tests?
- Chest x-ray
- Electrocardiography (ECG)
- Complete Blood Count (CBC)
- Electrolyte levels
- Urinalysis
What type of medication classes carry surgical risks?
- Anticoagulants
- Duretics
- Transquilizers
- Adrenal steroids
- Antibiotics (mycin group)
What are the surgical risks of taking “anticoagulants” (heparin)?
risk for bleeding
which can precipitate hemmorhage.
What are the surgical risks of taking “antibiotics” (mycin group)?
Can cause respiratory paralysis when combined with certain muscle relaxants.
What are the surgical risks of taking “adrenal steroids” (cortisol)?
Abrupt withdrawl of steroid can cause cardiovascular collapse.
What are the surgical risks of taking “tranquilizers” (diazepam)?
risk for unstable blood pressure
Increase hypotensive effects of anesethetic drugs
What are the surgical risks of taking “diruetics” (furosemide)?
risk for electrolyte imbalance
which can cause respiratory depression.
What are some herbal supplments that carry surgical risk?
- Triple G (Garlic, Ginger, Gingko)
- St. Johns Wort
- Aspirin
- Valerian
- Echinacea & Kava
What are some Nursing “implementations” that need to be checked of on the day of the surgery?
- Check of vital signs (inform provider of abnormalities)
- Verify adherence to food/fluid restrictions before surgery.
- Have patient empty bladder before surgery.
- Adminster preoperative medication as ordered.
What is atelectasis?
What is a Nursing Intervention to address it?
Complete or partial collapse of a lung or a section (lobe) of a lung.
Instruct patient on the use of an incentive spirometer.
What is the function of the upper airways?
What are the structures?
- warm, filter, and humidify inspired air
- nose, pharynx, larynx, epiglottis.
What is the function of the lower airways?
What are the structures?
- Functions:
- conduction of air
- mucocilary clearance
- production of pulmonary surfactant
- Trachea, bronchi, bronchioles, and alveoli
- Do arteries or vein carry oxygen-poor to the lungs?
- Do the lungs oxygenate arteries or veins? What is it called?
- left/right pulmonary artery
- Pulmonary veins
Which parts are involved with normal breathing?
- Diaphragm
- External intercostals
Which respiratory organ is the site of gas exchange?
At the end of the terminal bronchioles, there are clusters of alveoli that are the site of gas exchange.
The wall of each alveolus is made of a single-cell layer of squamous epithelium. This thin wall allows for exchange of gases within the capillaries covering the alveoli.
What is Orthopnea?
Orthopnea is the inability to breath easily except in an upright position.
What is Tachypnea?
Tachypnea is fast respiratory rate (>20 breaths/min)
What is Apnea?
When is it a concern?
Apnea is temporary cessation of breathing.
Apnea is a concern when sleeping.
Which respiratory breath sounds are described
“Soft, high-pitched popping sounds during inspiration caused by terminal airways opening when fluid is present in the alveoli.”
Indicative of possible fluid in lungs (ammonia, pulmonary edema) specifically alveoli.
Crackles
what is bradypnea?
slow respiratory rate (<12 breathes per min)
what respiratory breath sound is described
“Continuous musical sound associated with airway narrowing, such as edema of the bronchi”
Can be heard with patients with asthma, allergies
Wheezing
What is a subjective experience that describes difficulty breathing; shortness of breath
Dyspnea
What are Kussmaul respirations?
rapid, deep respirations associated with acidic environment (such as diabetic ketoacidosis)
Why would patients with cardiac problems (congestive heart failure) have subsequent respiratory problems?
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs. This fluid reduces normal oxygen movement through the lungs.These two factors combine to cause shortness of breath
why can chronic illness overall leading to muscle weakness effect respiratory function?
Muscles that work with inspiration/expiration can be weakened
What class of medication can cause respiratory depression?
- Opioids (analgesics), narcotics
- Benzodiazepines (Xanax, Valium, Ativan)
What is respiratory depression?
Respiratory depression happens when the lungs fail to exchange carbon dioxide and oxygen efficiently
What is aspiration?
when something (food) enters your airway or lungs by accident
Crackles heard at the end of deep respiration are normal in which age population?
infants
which bed positioning promotes the best respiratory rate?
High-Fowlers
What causes “crackle” respiratory sounds?
when air passes through fluid, pus, or mucus.
What causes “wheezing” sound?
When air passes through and obstructured, narrow airway (tumor, edema)
What is normal atmospheric air %?
(what be breathe in normally)
21%
What is the max liter a nurse can administer without a doctors order for a nasal cannula?
2 L - 28%
What is the max liters a nasal cannula can adminster and what % is it?
6 L per min / 44%
What can happen to blood when too much oxygen is given?
Raises blood pH levels
Which oxygen delivery masks causes patient to only breathe in what’s in the bag.
Non-rebreathing Mask
- What is a pleura effusion?
- What can occur?
- What procedure is done to remedy it?
- buildup of fluid in the pleura space of the lungs.
- Compress or collapse lungs during respiration
- Thoracentesis - needle placed into pleural space to pull out fluid.
Which of these types of cough medication help clear mucus (phlegm) from your airway?
- Cough suppressant
- Expectorant
- Lozanges
Expectorants
Which of these types of cough medication areused to temporarily help relieve symptoms such as sore throat, throat irritation, or cough (due to a cold, for example). It works by providing a cooling feeling and increasing saliva in the mouth
- Cough suppressant
- Expectorant
- Lozanges
Lozanges
What are the upper chambers of the heart called?
What is their function?
Atria
To recieve blood from the veins
What are the lower chambers of the heart called?
What are their functions?
Ventricles
To force blood out through the arteries
- What is hypoxia?
- What can it lead to?
- Hypoxia is Inadequate supply of oxygen to the tissues (cells).
- It can lead to cellular acidosis, cell death and organ failure.
What is cardiac output?
Cardiac output is the amount of blood ejected from the left ventricle over 1 minute
the dusky color of skin (gray or blue) is called?
cyanosis
What is Ischemia?
What can it cause?
Ischemia is deficient blood supply. (trauma causing blood wound)
Deficiency can lead to hypoxia.
what is tachycardia?
Tachycardia is Fast heart rate (>100 beats/min)
What is angina?
Angina is pain due to inadequate oxygenation of heart muscle
What is bradycardia?
Bradycardia is slow heart rate (<60 beats/min)
What is myocardial infarction
myocardial infarction (MI) is death of heart muscle due to lack of blood flow.
What is dysrhythmia (arrhythmia)?
Improper beating of the heart, whether irregular, too fast, or too slow.
What is Cardiac coronary catheterization?
Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. Cardiac catheterization is used to study the various functions of the heart.
What is a Holter monitor?
a Holter monitor is a small, wearable device that records the heart’s rhythm usually for 24 hours.
What is perfusion?
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue.
What are signs for poor perfusion?
- Pulse in specfic area is +1
- cold skin
- poor capillar refill
- Decreased vitals (low BP, RR, HR)
What does arterial blood gas (ABG) test measure?
What is it used to find out?
arterial blood gases (ABG) test measures the following in the blood from an artery:
- the acidity (pH)
- levels of oxygen
- levels of carbon dioxide
This test is used to find out how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.
Which wave does the ECG/EKG begin with?
What does the letter represent?
P = atrial depolarization
What does the QRS on an ECG/EKG represent?
ventricular contraction
What does the T phase in an ECG/EKG represent?
Ventricular repolarization (relaxation)
When a thombus (blood clot) enters circulation what is it called?
embolism
Why should you not use compression sleeves on a DVT?
Compression may dislodge the clot and go to the lungs causing pulmonary embolism.
What are the 4 Nursing Interventions to promote proper breathing
- Deep breathing
- Use of incentive spirometry
- Pursed-lip breathing
- Diaphragmatic breathing
The nurse is assessing patients who will receive general anesthesia. The nurse identifies that the patient who is at the greatest risk for complications is the patient with a diagnosis of:
- Gastroesophageal reflux disease (GERD)
- Hypertension
- Hypothyroidism
- Emphysema
Respiratory problems complicate the administration of inhalation anesthesia.
Emphysema is characterized by the destruction of alveoli, loss of elastic recoil, and narrowing of bronchioles, which result in alveolar hyperinflation and increased airflow resistance.
